Page 10 - Work Life and Benefits Booklet 2020 SDC EDC

HMO Plans (available in CA only) Glossary of Terms
With the Deductible HMO & HMO plan, you must choose a Primary Care Physician (PCP) within
the Aetna network of providers for you and all your covered family members. Your PCP will
coordinate all of your care, including any specialty care, as that generally requires a referral or DEDUCTIBLE COINSURANCE
authorization. Benefits are covered under your assigned medical group and services received
outside of the HMO network are not covered, except in the case of an emergency. The amount of out-of-pocket
A cost sharing agreement
OAMC/PPO/HSA Plans expenses that you must pay between the insurance
The OAMC/PPO plan gives you the freedom to direct your own care, self-refer to a specialist and for before any expenses are company and the insured
you are not limited to the physicians within the Aetna network. However, you will maximize your payable by the plan. where payment
benefits and reduce your out-of-pocket costs if you choose a provider who participates in the responsibility is shared for
Aetna network. The calendar year deductible must be met before certain services are covered. On the HSA, you must meet all claims covered by the
your deductible before any policy, usually expressed as
The HSA plan is a high deductible PPO plan with the same PPO features, except it allows you to benefits are paid including a percentage.
take advantage of building a medical fund with pre-tax dollars and stays with you forever!
prescription drugs.
PLAN DIFFERENCES DED HMO FULL HMO HSA PPO OAMC/PPO OUT-OF-POCKET
Employee Premiums $ $$ $$ $$$ COPAY MAXIMUM
Out-of-Pocket Costs $ $ $$ $$ The flat dollar amount a The annual maximum
Contribution, Contribution, Contribution, covered individual is required amount of money you will
Copay,
Cost Sharing Deductible, Contribution, Deductible, Deductible, to pay for certain services pay in addition to copays
Copay
Copay Coinsurance Coinsurance (could be before or after and deductibles. After you
Network Size     meeting any applicable reach your out-of-pocket
deductible).
maximum, benefits are
In-Network Benefits ✓ ✓ ✓ ✓ free (in-network only).
Non-Network Benefits ✓ ✓

Access to Providers PCP Managed PCP Managed You Manage You Manage
- Primary Care Physician Required Required Not Required Not Required
- Referral for Specialist Required Required Not Required Not Required

Educational Video
FINDING A MEDICAL PROVIDER
Go to www.aetna.com or call (866) 529-2517 for HMO | (877) 204-9186 for Deductibles, Copays, Coinsurance, and
HSA PPO. HMO members refer to the Deductible HMO or HMO network and Out-of-Pocket Maximums
OAMC/PPO/HSA members refer to the Open Access Managed Choice network http://video.burnhambenefits.com/terms/
when prompted.